The aim of this research is to find and compare the effect of close chain and open chain exercises with blood flow restriction in knee osteoarthritis on pain, range of motion, strength and functional performance in patients with knee osteoarthritis. Randomized controlled trials done at Railway General Hospital and Medistic Medical and Dental Center, Rawalpindi. The sample size was 40. The subjects were divided in two groups, 20 subjects in close chain exercises with blood flow restriction group and 20 in open chain exercises with blood flow restriction group. Study duration was of 4 weeks. Sampling technique applied was purposive non probability sampling technique. Only 45-75 years individual with grade 1 or 2 knee osteoarthritis were included. Tools used in the study are Numeric pain rating scale (NPRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), goniometer, crane scale (dynamometer), 30 s chair stand test. Data was analyzed through SPSS 21.
Radiologic confirmation of KOA demonstrating Kellgren-Lawrence grade 1 or 2.
Exhibited symptoms of unilateral KOA.
Not taking any medications for KOA or receiving other treatments (including physiotherapy).
Willing to participate without any neurological symptoms were the main objects of study.
A history of knee surgery or scheduled surgery.
Kellgren-Lawrence grade 3 or 4.
Systolic blood pressure over 160 mm Hg or under 100 mm Hg.
Use of nonsteroidal anti-inflammatory drugs in the past 3 months.
Parallel
Closed kinetic chain exercises with blood flow restriction
Other interventionClosed kinetic chain exercises with blood flow restriction and conservative therapy. Participants in this group will receive conventional physiotherapy including hot pack application over the knee for 10 minutes and TENS applied medial and lateral to the knee for 10 minutes prior to exercises. Mulligan mobilization with movement will be performed using pain free sustained tibial glides during active knee flexion and extension. Closed kinetic chain quadriceps strengthening exercises will include seated heel press, mini squats, wall slides, step ups, and step downs performed under blood flow restriction. Exercises will be performed using a standardized blood flow restriction protocol of 4 sets with repetitions of 30, 15, 15, and 15 at low load. Sessions will be conducted 3 days per week for 4 weeks, with a total of 12 sessions, each session lasting approximately 40 minutes.
Open kinetic chain exercises with blood flow restriction
Other interventionOpen kinetic chain exercises with blood flow restriction and conservative therapy. Participants in this group will receive conventional physiotherapy including hot pack application over the knee for 10 minutes and TENS applied medial and lateral to the knee for 10 minutes prior to exercises. Mulligan mobilization with movement will be performed using pain free sustained tibial glides during active knee flexion and extension. Open kinetic chain quadriceps strengthening exercises will include straight leg raises and knee extension exercises performed under blood flow restriction. Exercises will be performed using a standardized blood flow restriction protocol of 4 sets with repetitions of 30, 15, 15, and 15 at low load. Sessions will be conducted 3 days per week for 4 weeks, with a total of 12 sessions, each session lasting approximately 40 minutes
Numeric Pain Rating Scale (NPRS)
Changes from baseline pain intensity will be assessed using the Numeric Pain Rating Scale. The Numeric Pain Rating Scale is a subjective pain assessment tool ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Participants will be asked to rate their average knee pain intensity at rest and during activity. NPRS is widely used in clinical practice due to its simplicity, reliability, and responsiveness to change in musculoskeletal conditions.
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
Changes from baseline pain, stiffness, and physical function will be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, a validated questionnaire for individuals with knee osteoarthritis.
Knee Range of Motion (Flexion)
Changes from baseline knee flexion range of motion will be measured using a universal goniometer following standard procedures.
Knee Range of Motion (Extension)
Changes from baseline knee extension range of motion will be measured using a universal goniometer in a standardized position.
Knee Muscle Strength
Changes from baseline knee extensor muscle strength will be assessed using a crane scale (dynamometer) in a standardized testing position.
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